Shared decision making has become the standard of care, yet there remains no consensus about how it should be conducted. Most accounts are concerned with threats to patient autonomy, and they address the dangers of a power imbalance by foregrounding the patient as a person whose complex preferences it is the practitioner's task to support. Other corrective models fear that this level of mutuality risks abdicating the practitioner's responsibilities as an expert, and they address that concern by recovering a nuanced (...) but genuinely directive clinical role. Cribb and Entwistle helpfully categorize models of shared decision making as ‘narrower’ and ‘broader’ and praise the latter's ‘open‐ended and fully dialogical ways of relating’. However, they stop short of providing a philosophical account of how that dialogue works. In this paper, a nurse–midwife and a philosopher collaborate to argue that the Socratic model of dialogue offers a solution to the practitioner–patient dilemma. In the Theaetetus, Socrates compares dialogical reasoning to ‘midwifery with all its standard features’. By means of a three‐way analogy, elements of midwifery practice are used to illuminate features of Socrates' claim that his dialogue is like midwifery; those features are then translated into an approach to shared decision making as the ‘midwifery of good thinking’ which both midwives and physicians would do well to adopt. A key concept that emerges is the need for practitioners to make a risk‐confidence assessment of the particular content of any decision to appropriately modulate their role in the practice of shared decision making. (shrink)

This book explores Goethe's ethics of happiness and the role of resignation within them. Prandi has carefully separated autobiographical material from literary expository of these themes in order to clarify the misunderstanding that has resulted from relying on Goethe's fictional works to document his personal ethical convictions. The book aims in part at working out in detail the usefulness of Spinoza's Ethics in evaluating ethical views expressed in poetry and fiction; and in part at correcting erroneous and confused ideas about (...) Goethean resignation. Prandi studies the 'natural morality' Goethe developed and practiced, using Lucretius and Spinoza as models of influence. All three define the good as what makes people rationally happy; each has his own resignation model to offer. From a deep analysis of views on happiness and resignation, the author's discussion leads to some surprising new conclusions. (shrink)

A 2011 National Academies of Sciences report called for an “Information Commons” and a “Knowledge Network” to revolutionize biomedical research and clinical care. We interviewed 41 expert stakeholders to examine governance, access, data collection, and privacy in the context of a medical information commons. Stakeholders' attitudes about MICs align with the NAS vision of an Information Commons; however, differences of opinion regarding clinical use and access warrant further research to explore policy and technological solutions.

Presents a plethora of approaches to developing human potential in areas not conventionally addressed. Organized in two parts, this international collection of essays provides viable educational alternatives to those currently holding sway in an era of high-stakes accountability.

Antibiotic resistance has become a problem of global scale. Resistance arises through mutation or through the acquisition of resistance gene(s) from other bacteria in a process called horizontal gene transfer (HGT). While HGT is recognized as an important factor in the dissemination of resistance genes in clinical pathogens, its role in the environment has been called into question by a recent study published in Nature. The authors found little evidence of HGT in soil using a culture‐independent functional metagenomics approach, which (...) is in contrast to previous work from the same lab showing HGT between the environment and human microbiome. While surprising at face value, these results may be explained by the lack of selective pressure in the environment studied. Importantly, this work suggests the need for careful monitoring of environmental antibiotic pollution and stringent antibiotic stewardship in the fight against resistance. (shrink)

Medical aid in dying (MAiD), despite being legal in many jurisdictions, remains controversial ethically. Existing surveys of physicians’ perceptions of MAiD tend to focus on the legal or moral permissibility of MAiD in general. Using a novel sampling strategy, we surveyed physicians likely to have engaged in MAiD-related activities in Colorado to assess their attitudes toward contemporary ethical issues in MAiD.

The Patient Self Determination Act of 1991 brought much needed attention to the importance of advance care planning and surrogate decision-making. The purpose of this law is to ensure that a patient’s preferences for medical care are recognized and promoted, even if the patient loses decision-making capacity. In general, patients are presumed to have DMC. A patient’s DMC may come under question when distortions in thinking and understanding due to illness, delirium, depression or other psychiatric symptoms are identified or suspected. (...) Physicians and other healthcare professionals working in hospital settings where medical illness is frequently comorbid with depression, adjustment disorders, demoralization and suicidal ideation, can expect to encounter ethical tension when medically sick patients who are also depressed or suicidal request do not resuscitate orders. (shrink)

We know that reading involves coordination between textual characteristics and visual attention, but research linking eye movements during reading and comprehension assessed after reading is surprisingly limited, especially for reading long connected texts. We tested two competing possibilities: (a) the weak association hypothesis: Links between eye movements and comprehension are weak and short‐lived, versus (b) the strong association hypothesis: The two are robustly linked, even after a delay. Using a predictive modeling approach, we trained regression models to predict comprehension scores (...) from global eye movement features, using participant‐level cross‐validation to ensure that the models generalize across participants. We used data from three studies in which readers (Ns = 104, 130, 147) answered multiple‐choice comprehension questions ~30 min after reading a 6,500‐word text, or after reading up to eight 1,000‐word texts. The models generated accurate predictions of participants' text comprehension scores (correlations between observed and predicted comprehension: 0.384, 0.362, 0.372, ps <.001), in line with the strong association hypothesis. We found that making more, but shorter fixations, consistently predicted comprehension across all studies. Furthermore, models trained on one study's data could successfully predict comprehension on the others, suggesting generalizability across studies. Collectively, these findings suggest that there is a robust link between eye movements and subsequent comprehension of a long connected text, thereby connecting theories of low‐level eye movements with those of higher order text processing during reading. (shrink)

Drawing on a landscape analysis of existing data-sharing initiatives, in-depth interviews with expert stakeholders, and public deliberations with community advisory panels across the U.S., we describe features of the evolving medical information commons. We identify participant-centricity and trustworthiness as the most important features of an MIC and discuss the implications for those seeking to create a sustainable, useful, and widely available collection of linked resources for research and other purposes.

Is there any ethical justification for limiting the reproductive autonomy and not make assisted reproductive technologies available to certain prospective parents? We present and discuss the results of an interdisciplinary clinical ethics study concerning access to assisted reproductive technologies (ART) in situations which are considered as ethically problematic in France (overage or sick parents, surrogate motherhood). The study focused on the arguments that people in these situations put forward when requesting access to ART. It shows that requester’s arguments are based (...) on sound ethical values, and that their legitimacy is at least as strong as that of those used by doctors to question access to ART. Results reveal that the three implicit normative arguments that founded the law in 1994, which are still in force after the bioethics law revision in July 2011—the welfare of the child, the illegitimacy of a “right to a child,” and the defense of the so called “social order”—are challenged on several grounds by requesters as reasons for limiting their reproductive autonomy. Although these results are limited to exceptional situations, they are of special interest insofar as they give voice to the requesters’ own ethical concerns in the ongoing political debate over access to ART. (shrink)

Mentoring Away the Glass Ceiling in Academia: A Cultured Critique describes how women of diverse backgrounds perceive their mentoring experiences or the lack of mentoring experiences in the academy. This book provides a space for envisioning strategies and practices to improve mentoring practices and the collegiate environment.

The study explored the motivations behind Australian wool producers’ intentions regarding mulesing; a surgical procedure that will be voluntarily phased out after 2010, following retailer boycotts led by People for the Ethical Treatment of Animals. Telephone interviews were conducted with 22 West Australian wool producers and consultants to elicit their behavioral, normative and control beliefs about mulesing and alternative methods of breech strike prevention. Results indicate that approximately half the interviewees intend to continue mulesing, despite attitudes toward the act of (...) mulesing being quite negative. This indicates that attitudes alone are unlikely to be good predictors of this goal directed behavior. Most respondents believed mulesing was more effective and involved less cost, time, and effort than the currently available alternatives to prevent breech strike. Further, they felt relatively little social pressure, as they believed few consumers were concerned about mulesing. However, they noted that if consumer sentiment changed they would likely change their practices. Thus, attitudes are likely to be only one of several factors influencing intentions to change farm practices to address societal concerns about animal welfare. Further, mulesing appears to be goal - directed behavior , suggesting that other factors depicted by the Model of Goal-directed Behavior (MGB; Perugini and Bagozzi In: Br J Soc Psychol, 40: 79–98, 2001 ) may be worth exploring in this context. Finally, these results provide insight into how policy makers may influence farmers to change practices in response to societal pressure for improving farm animal welfare. (shrink)

Cet essai vise à mettre au jour le mode de connaissance du principe qu'Albert le Grand déploie, dans son commencaire johannique, comme réponse à I'aporie des philosophes. II formule celle-ci à propos du verset Jn 1, 7 : "Et, bien qu'en elle-même elle la lumière soit très manifeste, cependant, notre intellect est, par rapport à elle, comme les yeux de la chauve-souris par rapport à la lumiere du soleil". C'est à partir de la notion de témoignage, dans laquelle il reconnait (...) la structure meme de l'Evangile de Jean, que le maître de Cologne développe la connaissance testimoniale comme voie vers le principe, alternative à la métaphysique. Cette enquête procède à partir des questions suivantes. (shrink)

The Protein Ontology (PRO; http://proconsortium.org) formally defines protein entities and explicitly represents their major forms and interrelations. Protein entities represented in PRO corresponding to single amino acid chains are categorized by level of specificity into family, gene, sequence and modification metaclasses, and there is a separate metaclass for protein complexes. All metaclasses also have organism-specific derivatives. PRO complements established sequence databases such as UniProtKB, and interoperates with other biomedical and biological ontologies such as the Gene Ontology (GO). PRO relates to (...) UniProtKB in that PRO’s organism-specific classes of proteins encoded by a specific gene correspond to entities documented in UniProtKB entries. PRO relates to the GO in that PRO’s representations of organism-specific protein complexes are subclasses of the organism-agnostic protein complex terms in the GO Cellular Component Ontology. The past few years have seen growth and changes to the PRO, as well as new points of access to the data and new applications of PRO in immunology and proteomics. Here we describe some of these developments. (shrink)

La defense d'un profond humanisme dont les racines puisent dans la Renaissance ainsi que le souci permanent d'une pedagogie exemplaire ont guide Genevieve Giudicelli-Delage durant toute sa carriere. Professeur emerite de l'Universite Paris 1 Pantheon-Sorbonne, ou elle a notamment dirige pendant de nombreuses annees le DEA devenu Master II de droit penal et politique criminelle en Europe, redactrice en chef de la Revue de science criminelle et de droit penal compare pour les editions Dalloz, presidente de l'Association de recherches penales (...) europeennes (ARPE), directrice de l'Ecole du Centre Ouest des avocats a Poitiers, Genevieve Giudicelli-Delage n'a cesse d'oeuvrer pour un depassement des frontieres disciplinaires et geographiques dans l'approche du phenomene criminel, ce dont temoignent en particulier son engagement en faveur du developpement du droit compare et son attachement a repousser les lignes d'horizons juridiques. Son regard sur le droit penal a profondement marque des generations d'etudiants et de doctorants. Par ses recherches individuelles, comme par les recherches collectives qu'elle mene admirablement, elle a egalement contribue au rayonnement doctrinal du droit penal en general, et de certaines de ses disciplines telles que le droit penal des affaires, le droit international penal, le droit penal europeen ou la procedure penale. C'est donc au chercheur comme au pedagogue que nous avons souhaite rendre hommage par ces Melanges regroupant une soixantaine d'auteurs, anciens eleves/collegues/amis, universitaires et/ou praticiens reunis autour du theme Humanisme et justice, que le Professeur Giudicelli-Delage a, par un soin constant, nourri et questionne durant toutes ses annees d'exercice. (shrink)

Où en sont aujourd'hui les études au sujet de Maître Eckhart (1260-1327), frère prêcheur et maître en théologie de l'université de Paris, dont plusieurs propositions ont été condamnées par le pape Jean XXII dans la bulle In agro dominico? De la variété et de la richesse des directions de recherche actuelles, ce volume en propose, conformément à l'esprit de la collection, une sélection. Quatre perspectives principales se dégagent. La première concerne les questions métaphysiques et théologiques majeures - Dieu, l'Un, la (...) Trinité, les transcendantaux - ainsi que la théorie de l'intellect. La deuxième regroupe les questions spirituelles, morales et anthropologiques soulevées par la réflexion eckhartienne. Une troisième s'intéresse aux auteurs aux-quels les textes d'Eckhart ouvrent, que ces auteurs précèdent ou suivent chronologiquement le maître thuringien : Plotin, Maïmonide, le Liber de causis et l'idéalisme allemand, Heidegger, Derrida ou encore les études comparatistes de Shizuteru Ueda avec le bouddhisme zen. Une quatrième manière de lire ce recueil consiste à suivre la distinction et la complémentarité de oeuvre latine et de oeuvre allemande de Maître Eckhart avec les différents problèmes herméneutiques et doctrinaux qu'elles posent. Que chaque lecteur puisse trouver à son gré, à travers les différences d'approches et de voix, ses propres chemins pour entrer dans oeuvre de Maître Eckhart. (shrink)

There is a critical inconsistency in the literature on analogical retrieval. On the one hand, a vast set of laboratory studies has found that people often fail to retrieve past experiences that share deep relational commonalities, even when they would be useful for reasoning about a current problem. On the other hand, historical studies and naturalistic research show clear evidence of remindings based on deep relational commonalities. Here, we examine a possible explanation for this inconsistency—namely, that remindings based on relational (...) principles increase as a function of expertise. To test this claim, we devised a simple analogy‐generation task that can be administered across a wide range of expertise. We presented common events as the bases from which to generate analogies. Although the events themselves were unrelated to geoscience, we found that when the event was explainable in terms of a causal principle that is prominent in geoscience, expert geoscientists were likely to spontaneously produce analogies from geoscience that relied on the same principle. Further, for these examples, prompts to produce causal analogies increased their frequency among nonscientists and scientists from another domain, but not among expert geoscientists (whose spontaneous causal retrieval levels were already high). In contrast, when the example was best explained by a principle outside of geoscience, all groups required prompting to produce substantial numbers of analogies based on causal principles. Overall, this pattern suggests that the spontaneous use of causal principles is characteristic of experts. We suggest that expert scientists adopt habitual patterns of encoding according to the key relational principles in their domain, and that this contributes to their propensity to spontaneously retrieve relational matches. We discuss implications for the nature of expertise and for science instruction and assessment. (shrink)

Pourquoi Sextus Empiricus, au chapitre 34 du livre I des Esquisses Pyrrhoniennes, refuse-t-il d’identifier la méthode des médecins empiriques à la « voie sceptique » qu’il tente de définir au livre I du même ouvrage – ce qui le distingue en particulier de Galien, qui ne semble pas mettre en doute la nature sceptique de la médecine empirique? L’examen de cette question nous donnera l’occasion de faire le point sur les procédures logiques utilisées par ces mêmes médecins empiriques, en particulier (...) sur l’épilogisme, ainsi que sur les conceptions étiologiques de l’école empirique, que nous opposerons à ce que l’on peut connaître des principes méthodologiques et physiologiques de la médecine méthodiste. (shrink)

À travers l’analyse d’une œuvre de Frida Kahlo, Autorretrato con Pelo Cortado (« Autoportrait aux Cheveux Coupés »), datée de 1940, nous nous proposons d’extraire la réflexion féministe de l’artiste sur le genre et l’ambiguïté sexuelle. Avec ses nombreux autoportraits, l’artiste nous a livré une fine analyse du statut et de la condition des femmes de son époque. En tant que femme artiste et femme d’artiste, Kahlo a toute sa vie cherché sa place socialement et professionnellement. Elle a mené une (...) œuvre dichotomique et pertinente quant aux relations hommes-femmes. Son visage et son corps sont progressivement devenus les instruments de sa critique. Autorretrato con Pelo Cortado atteint un haut degré critique, l’œuvre joue sur les complexités de la personnalité de Kahlo. En cela, elle nous apparaît être une œuvre manifeste reflétant la résistance de l’artiste face aux lois patriarcales du Mexique des années 1930-1950. (shrink)

El presente trabajo se propone estudiar las modalidades del aparecer de una imagen en el seno de una ficción, jugando sobre categorías tales como la substitución, la analogía, la permanencia o incluso la ausencia de lugar. Apoyándonos en la novela del escritor japonés Kawabata, titulada en su versión francesa Nuée d’oiseaux blancs (Nube de pájaras blancos), trataremos de mostrar cómo el deseo se encarna en determinadas huellas depositadas sobre objetos, y cómo la mirada del personaje masculino queda prendida en ellas (...) al extremo de perderse por entero en aquellas. (shrink)

Cet article aborde le péché capital d’ acedia ou acédie, pour déterminer s’il se caractérise plus essentiellement comme aversion ou comme indifférence. À partir de sa figure originaire, livrée par le théologien-ermite Évagre le Pontique, sera dépassée sa formulation comme odium professionis, haine de l’état monastique, au profit d’une hypothèse mettant en jeu à la fois indifférence et aversion, celle de l’insupportable indifférence. Cette hypothèse sera ultimement dépassée par la mise au jour d’un état plus profond d’indifférence à soi, menant (...) à la thèse ultime, kierkegaardienne, d’une défaillance éthique profonde dans l’acédie. (shrink)

Ce livre jette une lumière nouvelle sur l'empirisme d'Épicure et des épicuriens par le jeu d'une comparaison entre les méthodologies scientifiques épicurienne et médicale. C'est à partir d'une conception commune du savoir comme technè (art ou technique) que ces deux ensembles doctrinaux comprennent la nature et la source de la connaissance. L'épistémologie épicurienne apparaît comme une conception originale de la forme du discours scientifique et de l'explication causale.